Special Assistant United States Attorney

For each of the following question, please select the response that best describes your education and/or experience. You may only select one response for each question. If you feel that your education or experience exceeds all of the descriptions for a particular question, choose the description that is the closest level to the experience or education that you possess.

1. All Assistant United States Attorney applicants are required to certify that they are duly licensed to practice law as an attorney at the time of filing, under the laws of a State, the District of Columbia, the Commonwealth of Puerto Rico, or any territorial court established under the United States Constitution. Do you meet this requirement?

A. Yes - I hereby certify that I am duly licensed to practice law at the time of this filing for employment as an Assistant United States Attorney and am currently in good standing under the laws of a State, the District of Columbia, the Commonwealth of Puerto Rico, or any territorial court established under the United States Constitution.B. No- I do not certify that I am duly licensed to practice law at the time of the filing of this application for employment as an Assistant United States Attorney and am currently in good standing under the laws of a State, the District of Columbia, the Commonwealth of Puerto Rico, or any territorial court established under the United States Constitution.

Please answer YES, NO, or NOT APPLICABLE to the following condition of employment questions. If you respond "No" to any of these questions, you will be disqualified from further consideration.

2. A comprehensive background investigation, including a check of your credit history, is required for this position. Are you willing to authorize the release of your consumer/credit reports to DOJ in connection with your application for employment?

A. YesB. No

3. A comprehensive background investigation, including a criminal history and fingerprint check is required for this position. Are you willing to submit your fingerprints to DOJ and consent to a formal background investigation in connection with your application for employment?

A. YesB. No

4. A pre-employment drug screening is required for this position. Are you willing to undergo a drug screening?

A. YesB. No

5. This position requires that you uphold the highest ethical standards, including maintaining confidentiality of sensitive information. Are you willing to abide by all policies and procedures governing the protection of sensitive information?

A. YesB. No

6. If you are a male U.S. Citizen born after 31 December 1959, you are required to register with the Selective Service. Have you registered with the Selective Service? (Female applicants must select "C").

A. YesB. NoC. Not Applicable (I am either a female applicant, or male applicant born before 31 December 1959, or an applicant who meets exemptions under the Selective Service law)

Please answer YES, NO, or NOT APPLICABLE to the following condition of employment questions. A Yes answer does not necessarily disqualify a candidate from consideration. However, inaccurate or incomplete information regarding ethics and professionalism may prevent further consideration.

7. Have you failed to file or pay state or federal taxes for any year you were required to file returns or are you currently delinquent in the payment of state or federal taxes? If yes, please use the narrative box at the end of this section to fully describe the circumstances and resolution of the delinquency.

A. YesB. NoC. Not Applicable

8. Are you delinquent in the payment of any student loans? If yes, please use the narrative box at the end of this section to fully describe the circumstances and resolution of the delinquency.

A. YesB. NoC. Not Applicable

9. Have you ever had a state bar complaint filed against you or had your conduct referred to a state bar in any jurisdiction? If you respond yes to this question, please use the narrative text box at the end of this section to fully explain the circumstances, disclose the jurisdiction and the resolution.

A. YesB. No

10. Has your conduct ever been referred to the Office of Professional Responsibility, Department of Justice? If yes, please use the narrative text box at the end of this section to fully describe the circumstances and resolution of the referral.

A. YesB. NoC. Not Applicable - I am not currently nor have I been a Department of Justice attorney.

11. Has any court ever issued any sanctions, monetary or otherwise, against you or your client arising out of your conduct? If yes, please use the narrative text box at the end of this section to fully describe the circumstances and sanctions.

A. YesB. No

12. Have you or your employer ever reported your conduct or performance to a professional liability carrier? If yes, please use the narrative text box at the end of this section to fully describe the circumstances and resolution.

A. YesB. No

13. I certify that, to the best of my knowledge and belief, all of the information included in this questionnaire is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this application and its supporting materials, or in any document or interview associated with the examination process, I may be fined or imprisoned (18 U.S.C. 1001); my eligibilities may be cancelled, I may be denied an appointment, or I may be removed and debarred from Federal service (5 C.F.R. part 731). I understand that any information I give may be investigated. I understand that I will not be considered for employment if I do not respond "Yes" to this certification item.

A. Yes, I certify/understand the information provided above.B. No, I do not certify/understand the information provided above.